Do Surgical Times and Efficiency Differ Between Inpatient and Ambulatory Surgery Centers That are Both Hospital Owned?

Abstract

Purpose: The aim of this study was to examine the differences in primary anterior cruciate ligament reconstruction (ACLR) surgical time and operation room (OR) work efficiency between inpatient and ambulatory facilities within the same institution.

Methods: Patients studied included those who underwent primary ACLR at either the inpatient hospital or the ambulatory facility by a single orthopaedic surgeon on elective surgery days. Time variables were calculated for ACLR to compare the 2 facilities. The OR work efficiency was calculated as the percentage of work that was completed before mid-day that was determined by the midpoint of the surgical day at each facility.

Results: Two hundred twenty-seven ACLR surgeries were performed on 187 elective surgery days, 153 surgeries at the inpatient facility and 74 at the outpatient facility. The mean age at the time of surgery was 14.9±2.2 years. The ACLR surgeries at the ambulatory facility were of shorter duration than those at the inpatient facility (P<0.0001). One OR was most commonly utilized and 2 to 3 surgeries were performed on most surgery days at both facilities. Seven nurses served as alternating circulators at the ambulatory facility compared with 41 nurses serving in the same capacity at the inpatient facility. The median turnover time was longer at the inpatient facility compared with the ambulatory facility. OR work efficiency (work done before mid-day) was 72.5% at the ambulatory facility and 49.5% at the inpatient facility, P<0.0001. If 2 ACLR surgeries were performed consecutively, the surgery day lasted for 6 hours at the hospital-owned ambulatory surgery center compared with 9 hours at the inpatient hospital.

Conclusions: Despite the common variables of the same surgeon performing the same surgery at facilities owned by the same institution primarily working in a single OR, differences exist in OR procedure time and work efficiency.

Level of evidence: Level III.